Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes

Clin Infect Dis. 2016 Jun 25. pii: ciw416. [Epub ahead of print]

Impact of Opioid Substitution Therapy on Antiretroviral Therapy Outcomes: A Systematic Review and Meta-Analysis

BACKGROUND:

Human immunodeficiency virus (HIV)-infected people who inject drugs (PWID) frequently encounter barriers accessing and remaining on antiretroviral therapy (ART). Some studies have suggested that opioid substitution therapy (OST) could facilitate PWID’s engagement with HIV services. We conducted a systematic review and meta-analysis to evaluate the impact of concurrent OST use on ART-related outcomes among HIV-infected PWID.

METHODS:

We searched Medline, PsycInfo, Embase, Global Health, Cochrane, Web of Science, and Social Policy and Practice databases for studies between 1996 to November 2014 documenting the impact of OST, compared to no OST, on ART outcomes. Outcomes considered were coverage and recruitment onto ART, adherence, viral suppression, attrition from ART, and mortality. Meta-analyses were conducted using random-effects modeling, and heterogeneity assessed using Cochran Q test and I2 statistic.

RESULTS:

We identified 4685 articles, and 32 studies conducted in North America, Europe, Indonesia, and China were included. OST was associated with a 69% increase in recruitment onto ART (hazard ratio [HR], 1.69; 95% confidence interval [CI], 1.32-2.15), a 54% increase in ART coverage (odds ratio [OR], 1.54; 95% CI, 1.17-2.03), a 2-fold increase in adherence (OR, 2.14; 95% CI, 1.41-3.26), and a 23% decrease in the odds of attrition (OR, 0.77; 95% CI, .63-.95). OST was associated with a 45% increase in odds of viral suppression (OR, 1.45; 95% CI, 1.21-1.73), but there was limited evidence from 6 studies for OST decreasing mortality for PWID on ART (HR, 0.91; 95% CI, .65-1.25).

CONCLUSIONS:

These findings support the use of OST, and its integration with HIV services, to improve the HIV treatment and care continuum among HIV-infected PWID.

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Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal Australians

Prevalence of chlamydia, gonorrhoea, syphilis and trichomonas in Aboriginal and Torres Strait Islander Australians: a systematic review and meta-analysis

Sexual Health – http://dx.doi.org/10.1071/SH15171, Submitted: 25 August 2015  Accepted: 5 November 2015   Published online: 18 January 2016

Abstract:

Higher notification rates of sexually transmissible infections (STIs) are reported among Aboriginal and Torres Strait Islander (Aboriginal) compared with non-Aboriginal people in Australia.

The aim of this study is to estimate the pooled prevalence of chlamydia, gonorrhoea, syphilis and trichomonas among Aboriginal people in Australia by sex, age-group, setting (clinic vs population/community-based) and population group [adults, pregnant females, young people (12–29 years) and prisoners].

The databases Medline, PubMed and Web of Science were searched in May 2015. A meta-analysis was conducted to estimate the pooled prevalence of the four STIs in Aboriginal people and if possible, by gender, age-group, setting and population group. A total of 46 studies were included.

The pooled prevalence was 11.2% (95%CI: 9.4–13.0%) for chlamydia (36 studies), 12.5% (95%CI: 10.5–14.6%) for gonorrhoea (28 studies), 16.8% (95%CI: 11.0–22.6%) for syphilis (13 studies) and 22.6% (95%CI: 18.5–26.7%) for trichomonas (11 studies); however, there was significant heterogeneity between studies (I2 <97.5%, P < 0.01).

In the subgroup analysis, a higher pooled prevalence occurred in females than males for chlamydia (12.7% vs 7.7%) and gonorrhoea (10.7% vs 8.1%). The prevalence of chlamydia was 12.4% in clinic-based compared with 4.3% in population-based studies. The highest pooled prevalence by population group was among pregnant females (16.8%) and young people (16.2%) for chlamydia, pregnant females (25.2%) for trichomonas; and young people for gonorrhoea (11.9%).

This review highlights the need to decrease the prevalence of STIs among Aboriginal people through community-based programs that target asymptomatic young people.

Note: This is the abstract only, as the full text is via paid subscription only.  For full text access, please see your librarian or pay direct via journal website.

Meta-analysis confirms oral contraceptives reduce endometrial cancer risk

medwireNews 10 August 2015
Oral contraceptive use protects against endometrial cancer, with effects persisting for decades after cessation of use, shows a meta-analysis of individual patient data published in The Lancet Oncology.
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follow-up to post “Depo-Provera Linked to Increased HIV Risk in Africa”

Hi SASHA readers,

Some people have pointed out that the link in the previous post “Depo-Provera Linked to Increased HIV Risk in Africa” goes to a login page which locks them out. I found the article through google, and it turns out you can only access it in you go in that way, i.e. via google results. I was not aware of this when i posted it.

Cheers,

SASHA

 

Depo-Provera Linked to Increased HIV Risk in Africa

Medscape, January 09, 2015

The injectable contraceptive depot medroxyprogesterone (Depo-Provera or DMPA) is associated with elevated risk for HIV infection among women in low-income or middle-income countries of sub-Saharan Africa, according to a study.

The mechanism behind a link between DMPA and HIV infection is not known.

Read more here